The role of the neuropediatrician in pediatric intensive care unit: Diagnosis, therapeutics and major participation in collaborative multidisciplinary deliberations about life-sustaining treatments’ withdrawal

Abstract

NP are clearly involved in the decision-process of LLST for patients admitted in PICU, claiming for close collaboration to improve current practices and the quality of the care provided to children.

Exploring the Role of Pediatric Neurology in Determinations of Futility, Identifying Vulnerability, and Participating in Shared Decision Making through Case-Based Analysis

“…A retrospective study done at Pediatric Intensive Care Unit of Necker Hospital in 2014 aimed to assess the role that pediatric neurologists had in decisions regarding limiting life-sustaining therapy (LLST). 8 Of the 274 patients included in the study, over half of them (56%) were evaluated at some point by a pediatric neurologist, who had a role in diagnosis and/or treatment. A pediatric neurologist was involved in 59 to 100% of patients with acute neurological disease and 14 to 44% of patients with extra neurological failure (i.e., systemic diseases affecting the nervous system).…”

“…This is why the authors also point out that, "another thorny issue remains: the poor health-related quality of life of surviving patients. The concept of "relative futility" is dangerous as it introduces an unknown and potentially highly variable factor, a doctor's assessment on the patient's quality of life 8 ." This subjective determination of futility is at the heart of the case we are discussing.…”